Of all healthcare professionals, nurses are often the first to discover a patient of cardiopulmonary arrest (CPA) in any part of the hospital, be it the “emergency” or the “in-patient” wards. Therefore, it is needless to say that their competency in cardiopulmonary resuscitation (CPR) is a critical factor in determining successful outcomes in patients who develop CPA [1
]. Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for an infant, child, or adolescent who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest) [4
]. Of all patient care areas, the emergency and ICU are the places where most of the CPAs are witnessed (95%−98% of CPAs occur in these areas in our institute), as the critically ill or injured children are admitted or transferred to these areas. Therefore, the competence of the nurses posted in these acute care areas becomes very important. Competency in CPR is defined as acquisition
of CPR cognitive knowledge and skills in order that health care professionals will be able to perform CPR in a CPA situation [4
]. However, evidence is compelling to show that CPR knowledge and skills are poorly retained across nursing populations [7
Several studies had evaluated the knowledge and CPR performance skills of either in-service or preservice nurses individually and found decline in both domains with time. Irrespective of the status of baseline training of the participant, these studies showed considerable decrease in knowledge recall and skill performance even after short periods of time following completion of the courses [6
]. For example, a study on evaluation of abilities of nurses to retain basic/advanced life support skills and theoretical knowledge found that theoretical knowledge was retained but performance skills of the nurses degraded quickly [13
]. In another study from Bahrain [14
], the authors observed that only 7% of participants passed the knowledge test. A systematic review of studies on CPR retention over a 9-year period revealed poor knowledge and skills retention [10
]. All the studies included in the systematic review had dealt with adult CPR. Given the fundamental differences between the steps in adult and child CPR, the findings of these studies cannot be extrapolated to health professionals involved in care of sick children [15
]. To enumerate a few differences between child and adult CPR, the compression ventilation ratio for adult CPR is universal (30
2) irrespective of whether there is one rescuer or 2 rescuers whereas that for infant/child CPR is 15
2 for 2 rescuers and 30
2 for single rescuer. It is much simpler to remember one ratio instead of two. Within the pediatric age group the compression depth is different for infants and for children (4
cm or 1.5 inch and 5
cm or 2 inches resp.) whereas it is 2 inches or 5
cm in adults. The compression technique is not only different for infants and children, within infancy it is different for 1 rescuer and 2 rescuers (two fingers versus 2 thumbs encircling technique). The recommendation for the site of chest compression is also different for infants and children. With so many differences in the steps of CPR it is much more challenging to remember the steps and the sequence of skills in infants/children than adults. Therefore, it may not be surprising to find that the overall performance of nurses in terms of knowledge and skills in infant/child CPR may be poorer in comparison to their counterparts who are required to perform adult life support. However, there is a dearth of knowledge in this regard, and we could identify only one study till date by West [18
] which assessed the knowledge and skills of 6 registered nurses in infant/child CPR.
All the aforementioned studies had evaluated only a particular group of nurses (e.g., Madden [19
] evaluated only preservice nurses while Smith et al. [13
] evaluated in-service nurses), but none have compared both groups in the same setting. Studies have compared the knowledge and skill retention of nurses with those of doctors in basic and advanced life support [20
] and have found that nurses as first responders scored higher than the doctors in basic life support, while it was the other way round for advanced life support in which the doctors scored better than the nurse. The authors hypothesized that there would be differences between the nurses' and doctors' knowledge of CPR guidelines based on their motivation to learn and experience. On similar lines, we hypothesized that there would be important differences between the level of knowledge and skill retention with time, between in-service nurses and preservice nurses due to differences in their professional background and motivation to learn. We presumed that since in-service nurses are actively involved in resuscitation on a day-to-day basis their skills would be better than preservice nurses whose major academic curriculum is restricted to theoretical learning. On the other hand, student nurses would be better at retaining knowledge as they have the time and willingness to assimilate knowledge through reading the course material. They might therefore require more hands on training as their participation in infant/child CPR is most of the times only in assisting the in-service staff. We wanted to explore how these two groups would differ with regard to knowledge and skill acquisition and retention. We also wanted to decide the frequency of retraining/update so as to maintain quality of CPR performance and also a method of training suited to the needs of the particular group.
With this background, we aimed to compare the in-service and the preservice nurses' (a) baseline knowledge and skills in infant and pediatric CPR, (b) competence in acquiring the necessary knowledge and skills following recommended teaching methods, and (c) retention of knowledge and skills acquired following training at a prespecified time point.